The vast majority of people 65 or older who are eligible for Medicare or are enrolled in Medicare are not eligible to enroll in health coverage through Maryland Health Connection.
In general, most people get Medicare Part A (Hospital Insurance) for free, but some have to pay a premium for this coverage.
Individuals are eligible for Medicare Part A starting at age 65 with no cost if:
- They're a citizen or lawful permanent resident and the individual or their spouse has earned 40 credits (about 10 years of work); or
- The individual or their spouse is a government employee or retiree who hasn't paid into Social Security but has paid Medicare payroll taxes while working.
NOTE: An individual can qualify for Medicare based on a spouse's work record if the spouse is at least 62 and the individual is at least 65. An individual may also qualify based on the work record of a divorced or deceased spouse.
In addition, an individual under 65 may qualify for Medicare at no cost if:
- The individual has been entitled to Social Security Disability Insurance benefits for at least 24 months; or
- The individual receives a disability pension from the Railroad Retirement Benefits and meets certain conditions; or
- The individual has Lou Gehrig's disease (amyotrophic lateral sclerosis); or
- The individual has permanent kidney failure requiring regular dialysis or a kidney transplant — and the individual or their spouse has paid Social Security taxes for a certain length of time, depending on their age.
In general, someone may purchase Medicare coverage if they’re not eligible for Medicare Part A at no cost:
- if they're a citizen or legal resident for at least 5 years;
- age 65 or older; and
- pay premiums for Part A (hospital insurance). There are staggered premium rates depending on work credits (less than 30, 30-39, and then once a consumer reaches 40 credit they don't have to pay premiums).
Low-income individuals who buy-in to Medicare may be eligible for the Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) programs. These programs help offset the cost of purchasing Medicare coverage. Marylanders can apply for QMB and SLMB at their local department of social services office.
A consumer can enroll in Part B without buying Part A. But if the consumer buys Part A, they must enroll in Part B. The consumer can enroll in Part D without enrolling in Part A or B. The consumer will pay the same premiums as other enrollees for Part B and D.
There are exceptions that allow certain individuals who are enrolled in Medicare or eligible for Medicare to apply for coverage through Maryland Health Connection, including:
- Active Medicare enrollees who qualify as a parent/Caretaker Relative (CTR) (regardless of their age) may also qualify for Medicaid benefits
- Active recipients of Social Security Disability Insurance (SSDI) benefits who qualify for Medicare but are in the 24-month waiting period
- Everyone eligible for SSDI benefits is also eligible for Medicare after a 24-month qualifying period. Individuals in this waiting period may use Maryland Health Connection to apply for Qualified Health Plan and Medicaid coverage
Note: An individual eligible for Supplemental Security Income is automatically eligible for Medicaid.
For more information about Medicare eligibility and benefits, please visit: https://www.medicare.gov/eligibilitypremiumcalc/.